A Decalogue for Safer

Anesthesia Practices in México

FMCA Patient Safety Taskforce, Federación Mexicana de Colegios de Anestesiología.
Comité de Seguridad, Federación Mexicana de Colegios de Anestesiología. AC

Anestesia en México 2025;37(2): 185–187 https://doi.org/10.64221/aem-37-2-2025-001

To the Editor,

The recent outbreak of fungal meningitis linked to neuraxial anesthesia procedures has had devastating consequences in the regions of Durango and Tamaulipas, Mexico, extending across the border into Texas, USA. Caused by Fusarium solani, this outbreak has resulted in numerous deaths, triggering a national health alert. The first cases were reported in Durango, Mexico, in November 2022, and in Tamaulipas, Mexico, in May 2023. Procedures conducted in these two states resulted in 115 confirmed or probable cases and 57 deaths.

In response to these outbreaks, the Mexican Federation of Anesthesiology Colleges (FMCA) established a safety committee composed of patient safety researchers, anesthesiologists, surgeons, pharmaceutical advisors, and patients, along with international experts from various disciplines. The FMCA Safety Committee aims to improve anesthesiology services across Mexico by fostering relationships with pharmaceutical companies and government entities to change frameworks for enhanced patient safety. Additionally, we are conducting research in anesthesia within Mexico, performing human factors studies to improve patient safety, and implementing educational interventions to advance best practices in the field.

Based on the conclusions of 50 interdisciplinary meetings of the Safety Committee of the FMCA, this decalogue sets out ten fundamental principles to strengthen patient safety in anesthesiology in Mexico. Grounded in research, evidence, and the expertise of an international team of patient safety and anesthesiology experts, its purpose is to address systemic challenges in the healthcare system, shift risk assessment toward patient protection, enhance communication and teamwork, and implement stronger evidence-based protocols to improve anesthetic practice in the country.

Decalogue to Improve Anesthesia Safety in Mexico

1. 1. Standardize Training and Certification
   All anesthesiologists and healthcare providers should complete rigorous, standardized training programs with mandatory certification and regular recertification to ensure high levels of competence. Structured educational programs enhance both theoretical knowledge and practical skills in anesthesiology residents, improving overall proficiency and patient safety (1).
2. 2. Enhance Preoperative Evaluation Protocols
   Comprehensive preoperative evaluation protocols should be implemented to identify risk factors and tailor anesthesia plans to individual patients. This involves thorough medical history reviews, physical examinations, and necessary diagnostic tests, all of which are essential for patient safety and effective risk management in anesthesia (2,3).
3. 3. Develop and Enforce Safety Guidelines
   Strengthening national anesthesia safety guidelines ensures consistent practice across healthcare facilities. Beyond simply establishing protocols, fostering a culture of safety requires staff education, adequate resource allocation, and leadership commitment. Safety checklists, when properly implemented with sufficient staff training and dedicated time, effectively reduce operative mortality and morbidity (4).
4. 4. Invest in Modern Equipment and Technology
   Upgrading anesthesia machines, monitoring devices, and related equipment is essential for precision and safety. Regular maintenance and calibration must be mandatory to ensure reliability. Innovations in anesthesia technology, including automation and intelligent systems, have improved anesthetic delivery, reducing complications and enhancing patient outcomes (5).
5. 5. Implement Continuous Education and Training Programs
   Ongoing education and training should be required for anesthesiologists and support staff, incorporating advancements in anesthesia, emergency response, patient safety techniques, and communication strategies. Simulation-based training improves the speed and accuracy of invasive techniques, enhances cardiopulmonary resuscitation effectiveness, and strengthens teamwork in high-pressure situations (6,7).
6. 6. Establish Robust Incident Reporting Systems
   A non-punitive incident reporting system should be developed to encourage healthcare professionals to report anesthesia-related adverse events and near misses. Analyzing these reports can help identify trends and implement corrective actions. Effective reporting is facilitated by open communication, knowledge sharing, a non-punitive culture, and strong feedback mechanisms, ultimately enhancing patient safety (8).
7. 7. Improve Communication and Teamwork
   Encouraging open communication and teamwork among surgical teams—including anesthesiologists, surgeons, nurses, and support staff—enhances coordination and patient safety. Regular team meetings and debriefings promote a culture of collaboration. Strong preoperative teamwork, staff continuity during surgery, and effective interprofessional communication improve both patient outcomes and staff psychological safety (9).
8. 8. Ensure Adequate Staffing and Reasonable Work Schedules
   Addressing staffing shortages and implementing reasonable work schedules for anesthesia providers is essential to prevent fatigue-related errors. Proper rest and balanced shift patterns improve alertness, decision-making, and overall performance (10).
9. 9. Promote Industry and Government Improvements
   It is essential to strengthen communication and collaboration across different levels of the healthcare system, including regulatory authorities, the pharmaceutical industry, and healthcare professionals, to develop regulations and medications tailored to the needs of clinical anesthesia practice. Anti-counterfeiting strategies within the pharmaceutical supply chain have proven effective in reducing falsified medications in low- and middle-income countries (11).
10. 10. Promote Research, Innovation, and Regulatory Oversight
    Advancing anesthesia safety requires robust research initiatives focused on improving protocols, risk assessment strategies, communication, and human factors in anesthesia practice. Evidence-based education, regulatory oversight, and collaboration across healthcare levels are crucial for long-term safety improvements. However, real-world implementation requires formal system-based assessment and continuous regulatory support (12).

Ensuring anesthesia safety in Mexico requires a systemic transformation that prioritizes patient safety, fosters interdisciplinary collaboration, and strengthens regulatory oversight. By shifting risk assessment strategies, enhancing communication, and implementing evidence-based protocols, we can build a more resilient and reliable anesthesia system. Encouraging continuous education, fostering a culture of accountability, and aligning all levels of healthcare toward a unified safety framework will be essential in preventing future crises and improving patient outcomes.

Federación Mexicana de Colegios de Anestesiología A.C., Calle Versalles 162, Juárez, Cuauhtémoc, 06600 Ciudad de México, CDMX, México.
Teléfono: 55 2124 2013 · kiknhedz@gmail.com (editor) · Responsable: jchejfec@live.com